Bleomycin is a glycopetide antibiotic isolated from Streptomyces verticillus which has a wide spectrum of antitumor and antimicrobial activities and is currently used in treatment of certain neoplasms. Its selective effect on Squamous cell carcinoma was confirmed by Ichikawa(1969) and Ueno(1970).
Bleomycin inhibits the synthesis of DNA in animal cells and has some degree of selective toxicity against DNA virus infections.
The drug has been reported to be useful in the topical treatment of verrucae by Fujita et al., in 1971. Since then many physicians lave been using Bleomycin as topical therapeutic agent on warts, especially in Japan.
The authors used Bleomycin as topical antiwart agent utilizing needle free syringe : Dermo-Jet. 29 patients are studied, the clinical and histopathological changes are followed and reported.
The advantages of utilizing Dermo-Jet compared to that of usual needle syringe method are a) More accurate dosage of the drug can be infiltrated to the lesion, especially in the epidermis. b) Resulting pain is shorter in duration c) The fear, especially of children, created by the introduction of a hypodermic needle is diminished. d) The manipulation of this peculiar syringe may give the patients hypnotic effect.
Clinically 3 different ways of regressing processes are observed.
1. Casting off of dried keratinous material
2. Vesicle or pustule formation
3. Progressive diminution of the size of warts.
Histologic studies are carried out on 24, 48, 72 hours and I week after the injection.
1. The findings of specimens taken 24, 48, 72 hours after the injections include ;
a) Cells with small elongated deeply basophilic nuclei and eosinophilic cytoplasm whose boundaries are indistinct appeared in some areas of the epidermis.
In the lower most layer of the epidermis several rows of small cells with minute basophilic nuclei lie in palisade arrangement.
b) Loss of basal cell layer
c) Necrosis of epidermal cells
d) Subepidermal abscess
2. The findings of specimen taken 7 days after the injection are;
In the mid part of horny layer band like collection of yellowish-brown hemorrhage born material and small elongated deeply basophilic nuclei which were observed in 1. a) are seen. Directly beneath this area the epidermis showes no basal cell layer and many finger like projections of rete ridges which is far more in number than normal skin.
It is thought that healing process of wart through Bleomycin local injection can be accomplished by
1. The altered epidermal cells reject further wart virus replication and heals by casting off of all altered part of the epidermis.
2. The subepidermal abscess may brings wart to be cast off.
3. The wart virus be destroyed directly by Bleomycin.
Bleomycin treatment with Dermo-Jet has a definite place in the management of warts.
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